Over-prescription creates sea of pills, side effects

On Feb. 2, the Centers for Disease Control and Prevention (CDC) published their recommendation that sexually active women who are not using birth control should avoid all alcohol consumption in order to reduce the prevalence of fetal alcohol spectrum disorders (FASDs).

The announcement, titled “Alcohol and Pregnancy: Why take the risk?” explains that individuals with FASDs can have lifelong physical, behavioral, and intellectual issues that severely affect their quality of life, and notes that 100 percent of FASDs are completely preventable. The announcement goes on to explain that over three million women in the U.S., despite being sexually active, drink alcohol without the safety of birth control. The report notes that approximately half of all pregnancies in the U.S. are unplanned, and that most planned pregnancies are not noticed until four to six weeks after conception, which means that if a sexually active woman is drinking and not on birth control, she could be unintentionally exposing an unborn child to alcohol. In order to prevent this from happening, the CDC recommends that women in this situation avoid alcohol altogether.

The CDC’s announcement was met with mixed reactions, with many people saying the CDC’s recommendation was impractical, sexist, and condescending. Of interest to The Tartan, however, is the implication that the announcement has for the prescription of birth control and other pharmaceuticals in general.

While the CDC’s announcement can be viewed as a call for women to abstain from alcohol consumption out of concern for their potential unborn child, it can also be viewed as a promotion for the prescription of birth control. The CDC notes that abstaining from alcohol is only necessary if a woman is sexually active and not on birth control, and suggests that healthcare providers recommend birth control to women who are sexually active, not planning to get pregnant, and wish to drink alcohol. This push for all sexually active women to be on birth control poses problems, however, with regard to the over-prescription of pharmaceuticals.

The pill, which is currently the most common form of contraceptive, was approved for use by the FDA in 1960, and has been the most commonly used contraceptive since 1982. Since then, the pill has become a widely prescribed cure-all for a variety of issues beyond contraception including menstrual pain, acne, and endometriosis, a chronic disease of the uterine lining that causes severe pain and can lead to ovarian cysts, lesions, and infertility. As of 2011, 58 percent of all pill users said they used the pill for noncontraceptive reasons, with 14 percent saying they used the pill for only noncontraceptive reasons.

While it is undeniable that contraceptives like the pill provide a variety of benefits to many women, these types of contraceptives are also linked to an assortment of side effects. Common side effects include nausea, weight gain, and loss of libido. However, contraceptives have also been linked to more serious issues such as strokes, heart disease, and mental illness. A 2007 study from the Alfred Psychiatry Research Centre in Australia, for example, suggests a link between contraceptives and depression, although the study itself notes that more research is needed to reach a definitive conclusion.

The hazards of contraceptive pills were brought to the forefront in the early 2000s when a controversy exploded around Yaz, a new contraceptive released in 2001 by Bayer. The contraceptive was heavily advertised, and by 2006 it was the number one contraceptive. The overnight success of Yaz was short-lived, however, as reports of the drug causing an increased risk of blood clots began to surface. While all contraceptives can cause blood clots — approximately two in every 10,000 women taking contraceptives will experience a blood clot — studies reported to the FDA in 2009 suggested that Yaz put women at increased risk.
Once again, research on the topic proved frustrating, and definite conclusions were elusive. Some studies suggested that Yaz increased a woman’s risk of acquiring a blood clot by two to five times, while others suggested that there was no extra risk associated with Yaz. Various reports associated Yaz with approximately 100 deaths and thousands of injuries, although Yaz could not be definitively named as the cause. Bayer denied knowing anything about this increased risk, and was involved in a $20 million settlement that attempted to determine the risk associated with the drug, but no definite conclusions were ever made. Today, Yaz is still on the market, although the U.S. Food and Drug Administration (FDA) has altered the Yaz warning label to include a warning about the potential increased risk of blood clots.

The idea that contraceptives like the pill are widely accepted and heavily prescribed by health care providers, despite the colossal uncertainty that exists in the scientific community, raises questions about the safety of their prescription. Certainly they can provide many benefits, and could be preferable to unplanned pregnancy or severe disorders such as endometriosis, but do we really know enough about the side effects of these drugs to prescribe them to teens struggling with acne or women with any sort of menstrual discomfort?

Unfortunately, the story behind Yaz, and contraceptives in general, is far from unusual. There have been countless instances of other pharmaceuticals initially marketed for their remarkable effects that were later discovered to have calamitous side effects. Take Vioxx, for example, a drug first released in 1999 as a pain reliever for arthritis that was recalled five years later after being linked to a significant increased risk of heart attack and stroke. With an increase in pharmaceutical advertisements, consumers are now exposed to more synthetic drugs than ever before. In 2002, pharmaceutical companies spent approximately $4 billion on pharmaceutical advertisements. A third of all consumers who saw a pharmaceutical advertisement asked their doctor about the drug, and two thirds of these individuals eventually asked for a prescription. Since then, pharmaceutical advertisements have only increased, with many consumers gaining most or all of their information about pharmaceutical drugs from advertisements.

This is not to say that prescription drugs shouldn’t exist. The pharmaceutical industry helps billions of people deal with illnesses that could be crippling or life threatening without the aid of synthetic medication, but consumers need to be educated about all the risks and benefits associated with these drugs. Pharmaceutical drugs can have serious side effects; these drugs should be viewed with caution and used only when absolutely necessary in order to prevent over-prescription and undesired consequences.